Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

Nimer Adeeb; Basel Musmar; Hamza Adel Salim; Assala Aslan; Anika Alla; Nicole M. Cancelliere; Rachel M. McLellan; Oktay Algin; Sherief Ghozy; Mahmoud Dibas; Sovann V. Lay; Adrien Guenego; Leonardo Renieri; Joseph Carnevale; Guillaume Saliou; Panagiotis Mastorakos; Kareem El Naamani; Eimad Shotar; Kevin Premat; Markus Möhlenbruch; Michael Kral; Omer Doron; Charlotte Chung; Mohamed M. Salem; Ivan Lylyk; Paul M. Foreman; Jay A. Vachhani; Hamza Shaikh; Vedran Župančić; Muhammad U. Hafeez; Joshua S. Catapano; Muhammad Waqas; Vincent M. Tutino; Mohamed K. Ibrahim; Marwa A. Mohammed; M. Ozgur Ozates; Giyas Ayberk; James D. Rabinov; Yifan Ren; Clemens M. Schirmer; Mariangela Piano; Anna L. Kühn; Caterina Michelozzi; Stéphanie Elens; Robert M. Starke; Ameer Hassan; Mark Ogilvie; Anh Nguyen; Jesse Jones; Waleed Brinjikji; Marie T. Nawka; Marios Psychogios; Christian Ulfert; Jose Danilo Bengzon Diestro; Bryan Pukenas; Jan-Karl Burkhardt; Ricardo A. Domingo; Thien Huynh; Juan Carlos Martinez-Gutierrez; Muhammed Amir Essibayi; Sunil A. Sheth; Gary Spiegel; Rabih G. Tawk; Boris Lubicz; Pietro Panni; Ajit S. Puri; Guglielmo Pero; Erez Nossek; Eytan Raz; Monika Killer-Oberfalzer; Christoph J. Griessenauer; Hamed Asadi; Adnan Siddiqui; Allan L. Brook; David Altschul; Andrew F. Ducruet; Felipe C. Albuquerque; Robert W. Regenhardt; Christopher J. Stapleton; Peter Kan; Vladimir Kalousek; Pedro Lylyk; Srikanth Boddu; Jared Knopman; Mohammad A. Aziz-Sultan; Stavropoula I. Tjoumakaris; Frédéric Clarençon; Nicola Limbucci; Hugo H. Cuellar-Saenz; Pascal M. Jabbour; Vitor Mendes Pereira; Aman B. Patel; Adam A. Dmytriw

doi:10.3171/2024.5.JNS232204

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Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

Journal article

Peer reviewed

Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

Nimer Adeeb, Basel Musmar, Hamza Adel Salim, Assala Aslan, Anika Alla, Nicole M. Cancelliere, Rachel M. McLellan, Oktay Algin, Sherief Ghozy, Mahmoud Dibas, …

Journal of neurosurgery, pp.1-11

2024-10-11

DOI: https://doi.org/10.3171/2024.5.JNS232204

PMID: 39393093

Appears in Miller School of Medicine - Latest Publications

Abstract

OBJECTIVE The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors’ objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment. METHODS The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size. RESULTS The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters. CONCLUSIONS This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

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Title: Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization
Creators: Nimer Adeeb - Louisiana State University in Shreveport
Basel Musmar - Louisiana State University in Shreveport
Hamza Adel Salim - Louisiana State University in Shreveport
Assala Aslan - Louisiana State University in Shreveport
Anika Alla - Louisiana State University in Shreveport
Nicole M. Cancelliere - St. Michael's Hospital
Rachel M. McLellan - Massachusetts General Hospital
Oktay Algin - Ankara
Sherief Ghozy - Mayo Clinic
Mahmoud Dibas - Louisiana State University in Shreveport
Sovann V. Lay - Hôpital Purpan
Adrien Guenego - Erasmus Hospital
Leonardo Renieri - Azienda Ospedaliero-Universitaria Careggi
Joseph Carnevale - Presbyterian Hospital
Guillaume Saliou - University Hospital of Lausanne
Panagiotis Mastorakos - Thomas Jefferson University
Kareem El Naamani - Thomas Jefferson University
Eimad Shotar - Pitié-Salpêtrière Hospital
Kevin Premat - Pitié-Salpêtrière Hospital
Markus Möhlenbruch - University Hospital Heidelberg
Michael Kral - Paracelsus Medical University
Omer Doron - Massachusetts General Hospital
Charlotte Chung - NYU Langone Health
Mohamed M. Salem - University of Pennsylvania
Ivan Lylyk - Team
Paul M. Foreman - Orlando Health
Jay A. Vachhani - Orlando Health
Hamza Shaikh - Cooper University Health Care
Vedran Župančić - Sisters of Charity Hospital
Muhammad U. Hafeez - Baylor School
Joshua S. Catapano - Barrow Neurological Institute
Muhammad Waqas - University at Buffalo, State University of New York
Vincent M. Tutino - University at Buffalo, State University of New York
Mohamed K. Ibrahim - Mayo Clinic
Marwa A. Mohammed - Mayo Clinic
M. Ozgur Ozates - Ankara Yıldırım Beyazıt University
Giyas Ayberk - Ankara Yıldırım Beyazıt University
James D. Rabinov - Brigham and Women's Hospital
Yifan Ren - Austin Health
Clemens M. Schirmer - Geisinger Medical Center
Mariangela Piano - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Anna L. Kühn - Memorial Hospital
Caterina Michelozzi - IRCCS Ospedale San Raffaele
Stéphanie Elens - Azienda Ospedaliero-Universitaria Careggi
Robert M. Starke - University of Miami
Ameer Hassan - Valley Baptist Medical Center
Mark Ogilvie - University of Alabama at Birmingham
Anh Nguyen - University Hospital of Basel
Jesse Jones - University of Alabama at Birmingham
Waleed Brinjikji - Mayo Clinic
Marie T. Nawka - University Medical Center Hamburg-Eppendorf
Marios Psychogios - University Hospital of Basel
Christian Ulfert - University Hospital Heidelberg
Jose Danilo Bengzon Diestro - University of Toronto
Bryan Pukenas - University of Pennsylvania
Jan-Karl Burkhardt - University of Pennsylvania
Ricardo A. Domingo - Jacksonville College
Thien Huynh - Jacksonville College
Juan Carlos Martinez-Gutierrez - The University of Texas Health Science Center at Houston
Muhammed Amir Essibayi - Montefiore Medical Center
Sunil A. Sheth
Gary Spiegel - The University of Texas Health Science Center at Houston
Rabih G. Tawk - Jacksonville College
Boris Lubicz - Azienda Ospedaliero-Universitaria Careggi
Pietro Panni - IRCCS Ospedale San Raffaele
Ajit S. Puri - Memorial Hospital
Guglielmo Pero - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Erez Nossek - NYU Langone Health
Eytan Raz - NYU Langone Health
Monika Killer-Oberfalzer - Paracelsus Medical University
Christoph J. Griessenauer - Paracelsus Medical University
Hamed Asadi - NYU Langone Health
Adnan Siddiqui - University at Buffalo, State University of New York
Allan L. Brook - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Andrew F. Ducruet - Barrow Neurological Institute
Felipe C. Albuquerque - Barrow Neurological Institute
Robert W. Regenhardt - Harvard University
Christopher J. Stapleton - Brigham and Women's Hospital
Peter Kan - Baylor School
Vladimir Kalousek - Sisters of Charity Hospital
Pedro Lylyk - Team
Srikanth Boddu - University Hospital of Lausanne
Jared Knopman - University Hospital of Lausanne
Mohammad A. Aziz-Sultan - Ankara
Stavropoula I. Tjoumakaris - Thomas Jefferson University
Frédéric Clarençon - Pitié-Salpêtrière Hospital
Nicola Limbucci - New York Hospital Queens
Hugo H. Cuellar-Saenz - Louisiana State University in Shreveport
Pascal M. Jabbour - Thomas Jefferson University
Vitor Mendes Pereira - Harvard University
Aman B. Patel - Massachusetts General Hospital
Adam A. Dmytriw - Massachusetts General Hospital
Publication Details: Journal of neurosurgery, pp.1-11
Number of pages: 11
Academic Unit: UMMG Dept of Neurological Surgery; Miller School of Medicine
Language: English
Resource Type: Journal article
PMID: 39393093
Record Identifier: 991032429862502976